Pedroza Diego A, Yuan Xueying, Liu Fengshuo, Chan Hilda L, Zhang Christina, Bowie William, Smith Alex J, Calderon Sebastian J, Lieu Nadia, Wu Weiguo, Porter Paul, Sarkar Poonam, Zhao Na, Oehler Constanze V, Peller Ondrej, Gaber M Waleed, Zhu Qian, Perou Charles M, Zhang Xiang H-F, Rosen Jeffrey M
bioRxiv. 2025 May 6:2025.04.30.651522. doi: 10.1101/2025.04.30.651522.
Patients diagnosed with metastatic triple negative breast cancer (mTNBC) have limited treatment options, are more prone to develop resistance and are associated with high mortality. A cold tumor immune microenvironment (TIME) characterized by low T cells and high tumor associated macrophages (TAMs) in mTNBC is associated with the failure of standard-of-care chemotherapy and immune checkpoint blockade (ICB) treatment. We demonstrate that the combination of immunomodulatory metronomic Cyclophosphamide (CTX) coupled with anti-CSF-1R antibody targeted therapy (SNDX-ms6352) and anti-PD-1 (ICB), was highly effective against aggressive metastatic syngeneic null TNBC genetically engineered mouse models (GEMMs) that present with high macrophage infiltration. Mechanistically, CSF-1R inhibition along with CTX disrupted the M-CSF/CSF-1R axis which upregulated IL-17, IL-15 and type II interferon resulting in elevated B- and T cell infiltration. Addition of an anti-PD-1 maintenance dose helped overcome de novo PD-L1 intra-tumoral heterogeneity (ITH) associated recurrence in lung and liver mTNBC.
被诊断为转移性三阴性乳腺癌(mTNBC)的患者治疗选择有限,更容易产生耐药性,且死亡率较高。mTNBC中以低T细胞和高肿瘤相关巨噬细胞(TAM)为特征的冷肿瘤免疫微环境(TIME)与标准护理化疗和免疫检查点阻断(ICB)治疗的失败有关。我们证明,免疫调节性节拍性环磷酰胺(CTX)与抗CSF-1R抗体靶向治疗(SNDX-ms6352)和抗PD-1(ICB)联合使用,对具有高巨噬细胞浸润的侵袭性转移性同基因无TNBC基因工程小鼠模型(GEMM)非常有效。从机制上讲,CSF-1R抑制与CTX一起破坏了M-CSF/CSF-1R轴,该轴上调了IL-17、IL-15和II型干扰素,导致B细胞和T细胞浸润增加。添加抗PD-1维持剂量有助于克服与肺和肝mTNBC中从头PD-L1肿瘤内异质性(ITH)相关的复发。